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Q: Effects of Chronic Liver Disease on Blood Alcohol Content and Breathalyzer BAC ( Answered 4 out of 5 stars,   0 Comments )
Subject: Effects of Chronic Liver Disease on Blood Alcohol Content and Breathalyzer BAC
Category: Health > Medicine
Asked by: turtleheadtraders-ga
List Price: $200.00
Posted: 09 Oct 2006 13:47 PDT
Expires: 08 Nov 2006 12:47 PST
Question ID: 772077
I need specific research data and any law cases that define what
effect chronic liver disease has on Blood Alcohol Content and
specifically Breathalyzer readings after ingestion of a small amount
(6 oz or less) wine.
Request relates to a friend who is dying from Hepatitis C induced
liver disease who, at a dinner, ingested 6 oz of champagne over the
course of 15 minutes.  She then left and drove toward her home.  On
the way she was caught in a sobriety checkpoint stop.  She had liquor
on her breath and was given field sobriety tests which she passed. 
When administered a "breathalyzer" test she had a .20 reading.  She
was not drunk, or even tipsy.  One hour later she was again given a
breath test and blew a .19.  She was charged with DWI and her trial is
I have read on the internet that chronic liver and kidney disease can
cause false readings.  But the information is scarce and not
I need research and any court cases where this condition was found to
have an adverse effect on the breath test outcome.

Request for Question Clarification by pafalafa-ga on 10 Oct 2006 14:24 PDT

I just wanted to let you know that I've looked into this question in some detail.

You're right...quite a number of DUI lawyer sites mention liver
disease as a possibly defense.

However, in looking at:

--actual case law

--law journals and articles on DUI

--medical databases


--Taylor's 'Drunk Driving Defense' which is considered the definitive
resource for lawyers on this topic

I came up completely empty-handed in terms of any actual evidence that
diseases of the liver can, in any way, afect the outcome of the tests.

Sorry to be the bearer of this news, it doesn't seem as if there's
much of a thread to go on, here.

Of course, I'm not a legal expert, and you or your friend may want to
consult one before deciding how to proceed with this.

Best of luck,


Clarification of Question by turtleheadtraders-ga on 11 Oct 2006 03:47 PDT
Thank you for your response.  It still leaves the question of how a
145 lb woman can, after just 6 oz of wine have such a high reading.
Subject: Re: Effects of Chronic Liver Disease on Blood Alcohol Content and Breathalyzer B
Answered By: crabcakes-ga on 12 Oct 2006 22:39 PDT
Rated:4 out of 5 stars
Hello Turtleheadtraders,

   You are right - there is not a lot of information on this topic!

   Since alcohol is metabolized by the liver, a ?sick? liver, such as
one with Hepatitis C, would definitely metabolize alcohol at a slower
rate than one without hepatitis. You say your friend is dying, so she
may have cirrhosis. If so, metabolism of alcohol is greatly decreased.
Decreased metabolism causes a higher BAC, for a prolonged time.

 A doctor, on one forum states ?The liver damage is the most likely
reason why you are not able to metabolize the alcohol properly. I
would advise abstaining from alcohol until you can get to the bottom
of the liver damage.?

   Several things can cause one to be a slow metabolizer of alcohol,
which would cause an elevated BAC. I?m not an attorney either, and I
don?t know if the following will hold up in court. Please see an
attorney, who can advise your friend on her case.

   Alcohol is metabolized in the liver by an enzyme, alcohol
dehydrogenase. Note: ETOH = ethanol, the kind of alcohol contained in
beer, champagne, and liquor. Recent studies have shown that males have
more alcohol dehydrogenase in their stomachs, than women do.

   You can see by the chart on this site that for a woman to have a
0.2 BAC, she would have had to drink 4 drinks.

   ?The public most commonly associates BAC with drunk driving.
However, it is more accurate to refer to alcohol impaired driving
because one does not have to be drunk (intoxicated) to be demonstrably
impaired. Driving skills, especially judgment, are impaired in most
people long before they exhibit visible signs of drunkenness. While
most States define legal impairment for purposes of driving at a BAC
of 0.08 percent or higher, alcohol may cause deterioration in driving
skills at 0.05 percent or even lower. Alcohol depresses the central
nervous system, causing slowed reactions, and one?s ability to drive
is affected long before a BAC of 0.08 percent is reached.?

?Fatigue and stress - Physical, mental, or emotional fatigue and
stress make a person much more susceptible to the effects of alcohol.

Body type - An overweight person generally has a higher blood alcohol
concentration than a muscular person who weighs the same and drinks
the same amount of alcohol. This is because muscle tissue has more
blood to dilute the alcohol.?

?WARNING: Some illegal drugs (marijuana) and prescription medicine
(e.g., cough syrups) can increase impairment levels by as much as five

 ?In the case of ETOH, the alcohol is metabolized in the liver by the
enzyme alcohol dehydrogenase, to acetaldehyde which causes dilatation
of the blood vessels and, after accumulation, is responsible for the
subsequent hangover which ensues. The acetaldehyde is subsequently
metabolized by the enzyme aldehyde dehydrogenase to acetate, a
substance very similar to acetic acid or vinegar. In fact, measurement
of blood serum acetate levels may be an indicator of "problem or
chronic drinking"

Certain drugs can inhibit the alcohol dehydrogenase enzyme responsible
for the first step in metabolizing ETOH. Inhibition of this enzyme
causes an increase in the blood alcohol level. Some of these drugs are
probably known to you. Antabuse is used for the treatment of
alcoholism. People taking this drug can get very sick from ingesting
just a small amount of ETOH. Chloral hydrate is a sleeping pill that
when put into someone's drink is known as a "Mickey Finn". Some orally
administered antidiabetic drugs like Diabinese also cause an
"Antabuse-like" reaction and the inhalation of the solvent
trichloroethylene can also inhibit alcohol metabolism.

Subjects exposed to these drugs can ingest 1-2 drinks and have a blood
alcohol level 2-3 times higher than one would expect based on
classical prediction models described later in this presentation.
Although these individuals may test "drunk" on the breathalyzer or by
blood alcohol determination, they may have only ingested one or two
alcoholic drinks. (REALLY!)?

?If an individual is accustomed to having 2-3 (or more) alcoholic
drinks per day, with dinner or while watching TV after work, it is
quite likely that they will have developed some tolerance to the
intoxicating properties of alcohol and might not show signs of
intoxication even at BACs over 0.10%. On the other hand, an individual
who drinks infrequently would have developed no tolerance and might
show signs of intoxication at BACs below the statutory level.?
Copyright restrictions prohibit me from posting more from this site,
but please check the entire site, particularly the section marked
?Cross-Examining BACs?

    Alcohol metabolism can be inhibited by an organism that many
people have in their stomachs these days; a bacteria called
Helicobacter pylori, or H. pylori for short.
?Conclusions: The metabolism of small amounts of ethanol is attenuated
in subjects with H. pylori infection.?

  ?We have recently shown that Helicobacter pylori possesses marked
alcohol dehydrogenase (ADH) activity and is capable--when incubated
with an ethanol containing solution in vitro--of producing large
amounts of acetaldehyde. In the present study we report that some
drugs commonly used for the eradication of H. pylori and for the
treatment of gastroduodenal diseases are potent ADH inhibitors and,
consequently, effectively prevent bacterial oxidation of ethanol to

   ?We only have enough such that, for an average size person, it will
take about 90 minutes to metabolize 1 drink (typical oxidation rate is
100 mg ethanol/kg/hr = 11 ml/hr/70 kg individual). Therefore ... The
liver is the major site of this oxidation, as well as the site of
major destruction (cirrhosis) due to excessive amounts. Metabolism is
first to acetaldehyde by ADH then acetate by aldehyde dehydrogenase.
Intermediary metabolism is significantly perturbed due to the
limitations in reoxidizing the NADH, and the consequent upsets caused
by the excessive amounts of NADH (affects the cytoplasmic redox
potential) as well as acidosis from increased lactate levels.?

   ?Probably the factor that most significantly differentiates the
genders is that, as compared with men, many women (not all) have less
of the enzyme alcohol dehydrogenase in the lining of their stomachs.
This enzyme is the same one that is found in the liver that breaks
down alcohol into the byproducts that are less toxic to the liver (see
page XX). Thus, the reduced amount of alcohol dehydrogenase enzyme in
women increases the likelihood that they will absorb nonmetabolized
alcohol from their stomach linings directly into their bloodstreams.
 Hypothetically, if a man and a woman of equal size and weight each
consumes an equivalent amount of alcohol over the same span of time,
the woman will have a much higher blood-alcohol level than the man.
Once in their bloodstreams, high blood-alcohol levels circulate in
their bodies, placing women at increased risk for the toxic effects of
alcohol on their livers and other organs.?

Birth Control Pills, and the day of the month affect women?s alcohol metabolism
   ?Women metabolize alcohol less efficiently than men because the
female body has less alcohol dehydrogenase (ADH), the enzyme that
interacts with alcohol in the stomach before it enters the blood

This results in higher blood alcohol concentrations over a shorter
period of time, said Chris Dubbs, research specialist at the
Pennsylvania Substance Abuse and Health Information Center.?

   Delayed gastric emptying can delay alcohol metabolism
?Gastric emptying seems to be the most important determinant of the
rate of absorption of ethyl alcohol taken in orally. In general the
faster the gastric emptying, the more rapid absorption. Therefore,
factors, which influence gastric emptying, influence absorption. One
of the most important factors is the presence of food. Food delays
gastric emptying and therefore delays absorption of ethyl alcohol .
Interestingly, the type of food, whether fat, carbohydrate, or
protein, does not seem to be a factor in the absorption of ethyl

 Physiological factors such as strenuous physical exercise also delay
gastric emptying, thus decrease ethyl alcohol absorption. Additional
factors such as drugs (e.g. nicotine, marijuana, and ginseng), that
modify physiological factors regulating gastric emptying also modify
ethyl alcohol absorption in a predicted manner.?

   ?There one important biological difference between men and women
comes into play: Muscle tissue contains more water than fat tissue, so
men -- who have more muscle and less fat on the average than women --
can have about 10 percent more water in their bodies. If a lean man
and a lean woman of equal weight consume the same amount of liquor,
the woman is more adversely affected for this and other reasons.?

?It is also known that the menstrual cycle affects alcohol metabolism
in women. Women have been shown to develop their highest BAL's
immediately before menstruating, and their lowest on the first day of
menstruation. This can be related to hormone level shifts. There is
evidence which shows that premenstrual syndrome with its emotional and
physical discomfort and de-stabilized blood-sugar levels can trigger
excessive drinking by some women.?

   ?Time over which the alcohol is drunk: Rapid intake of alcohol
results in more alcohol in the stomach and small intestine. This
produces a larger gradient of alcohol and greater absorption into the
blood stream and thus distribution into the tissues including the
brain. If alcohol is taken in more rapidly than it is metabolized (1/3
oz to 1/4 oz. per hour in an average person), then the BAC continues
to rise.
3. Use of other drugs with alcohol: The utilization of other drugs at
the same time that alcohol is being drunk can result in increased
effects of the alcohol. This action can occur several ways including
enhancing the absorption and distribution of alcohol, action on the
same chemical systems in the brain as alcohol, and/or slowing the
metabolism of ethanol through competition at the liver for
metabolizing enzymes or even damage to the liver so it doesn?t work as
4. Previous drinking history: The previous drinking history is
influential in determining the effects of current alcohol consumption.
Often times, dependent upon the amount and timing of prior alcohol
consumption, the person will develop a tolerance. Tolerance to alcohol
can be loosely defined as needing alcohol to produce the same effect.
Therefore, a person who has developed tolerance will need more alcohol
to produce some of the same effects. It should be noted that not all
systems underlying behavior develop tolerance at the same rate. In
addition to tolerance, it is probably that after heavy long-term
drinking that damage has been done to the brain and to the liver. In
these cases response to alcohol may be different than that originally
seen and/or prolonged since the liver can?t metabolize the ethanol as
rapidly.? Again, please see the site for further information.

   ?Moderate alcohol consumption of  1?2 drinks per day has been
associated with a 30?50% increase in breast cancer risk. Individuals
differ in their ability to metabolize alcohol through genetic
differences in alcohol dehydrogenase (ADH), the enzyme that catalyzes
the oxidation of  80% of ethanol to acetaldehyde, a known carcinogen.
Individuals differ in their ADH genotype, and one locus in particular
(ADH3) is polymorphic in Caucasian populations. Using data from the
Long Island Breast Cancer Study Project, we examined whether fast
metabolizers of alcohol, as measured by the ADH31-1 genotype, have a
higher risk of breast cancer from alcohol intake compared with those
individuals who are slow metabolizers, but consume similar amounts of

   ?Hines' group studied the influence of the gene that encodes
alcohol dehydrogenase 3. That's the enzyme that begins the breakdown
of ethanol, the type of alcohol in most drinks. This gene has two
versions, one whose enzyme metabolizes alcohol faster than the other's

   ?The liver can metabolize only a certain amount of alcohol per
hour, regardless of the amount that has been consumed. The rate of
alcohol metabolism depends, in part, on the amount of metabolizing
enzymes in the liver, which varies among individuals and. In general,
after the consumption of one standard drink, the amount of alcohol in
the drinker's blood peaks within 30 to 45 minutes. (A standard drink
is defined as 12 ounces of beer, 6 ounces of wine, or 1.5 ounces of
80-proof distilled spirits, all of which contain the same amount of
alcohol.) Alcohol is metabolized more slowly than it is absorbed.
Since the metabolism of alcohol is slow, consumption needs to be
controlled to prevent accumulation in the body and intoxication.?

?One study found that subjects who drank alcohol after a meal that
included fat, protein, and carbohydrates absorbed the alcohol about
three times more slowly than when they consumed alcohol on an empty

   ?The term physical tolerance refers to the effect of a given dose
of alcohol on a person who is ill. The individual?s physical and
mental abilities, already diminished by illness, are further
diminished by the presence of alcohol. This effect does not work both
ways. For example, a person in superb physical health is not less
affected by alcohol than the average healthy individual.?

The Law and DWI/DUI
   ?Scientific studies have repeatedly confirmed the existence of
variability in individual alcohol tolerance. In a study reported in
Sullivan, Hauptman, and Bronstein, Lack of Observable Intoxication in
Humans with High Plasma Alcohol Concentrations, 32 Journal of Forensic
Sciences 1160 (1987), for example, hospital patients with a history of
alcohol abuse were clinically observed and tested after consuming
significant amounts of alcohol. The researchers found essentially no
correlation between the patients' BACs and their assessed levels of
intoxication. This lack of correlation was attributed to the high
tolerance developed from long-term alcohol abuse. See also Redmond,
Alcohol Blood Levels, 16 Annals of Emergency Medicine 374 (1987), in
which 20 patients studied in a detox unit of an English hospital
showed no ill effects after being admitted with BACs above the lethal
limit.? There?s plenty more on this site-please visit each site fro
complete information.

     ?The point is simply that since the intoxicating element,
alcohol, has no odor, the presence of an odor tells us only that a
beverage normally associated with the presence of alcohol has been
consumed in the relatively recent past. More important, it does not
tell us how much alcohol has been consumed. There is no correlation
between the amount of alcohol consumed and the odor, and certainly
none between the amount and the strength of the odor. Again, beer is
among the least intoxicating of beverages and yet leaves a strong odor
on the breath.?

   ?Unfortunately for those who stand accused of DUI, DWI, or any
other drinking and driving related offense, the ways in which the
breath testing machines can be in error are many indeed. They include
problems with mouth alcohol causing artificially high results,
non-specificity to alcohol (where other compounds are mistaken for
alcohol by the machine), radio frequency interference, calibration
errors, human error, and more.?

   ?There is a significant likelihood that a given subject will be in
the absorptive state when tested under field conditons.  Because of
large differences in arterial BAC and veinous BAC during absorption,
breath test results consistently overestimate the result that would be
obtained from a blood test -- by as much as 100% or more.  In order to
have some idea of the reliability of a given breath test result, it is
essential to determine by some objective means whether the subject is
in the absorptive or post-absorptive state.  In the absence of such
information, an appropriate value for the uncertainty associated with
the absorptive state should be applied to all breath test results.
Simpson, "Accuracy and Precision of Breath Alcohol Measurements for
Subjects in the Absorptive State", 33(6) Clinical Chemistry 753

The most recognized expert in the field, Professor Kurt Dubowski of
the University of Oklahoma, agrees with Simpson: "When a blood test is
allowed, an administered breath test is discriminatory, because in law
enforcement practice the status of absorption is always uncertain."

   ?Hundreds of cases involving breath-alcohol tests have been thrown
out by Seminole County judges in the past five months because the
test's manufacturer will not disclose how the machines work.

I think this is huge. (Think of the implications for voting systems,
for one.) And it's the right decision. Throughout history, the
government has had to make the choice: prosecute, or keep your
investigative methods secret. They couldn't have both. If they wanted
to keep their methods secret, they had to give up on prosecution.?


   ?When defending a DUI or DWI case, you have to be quite experienced
in this field to be successful. There is so much depending on the
outcome for your client that you have to be specialized in what you?re
doing. Approximately 2 million cases are filed with the courts every
year and this takes up a large portion of the court docket. DUI/DWI
has gone from being a minor offense to in some cases a felony and is a
very serious charge. Depending on the circumstances, it can lead to
the charge of manslaughter or murder.

 To defend charges such as this takes a definite knowledge of the law
pertaining to these matters. Along with the charges come a few myths
and this is where some lawyers go wrong.? Please see this site (and
allt he sites I have posted) for complete information.

  The fact that your friend tested 0.20 on the breathalyzer, and one
hour late tested 0.19 is pretty consistent, and would be an expected
result. Was a blood alcohol drawn? Even with any of the above factors
possibly causing a falsely elevated BAC, it would be difficult to
prove that she had only 6 oz. of champagne. If the blood alchol
disputed the breath alcohol, you may have some teeth to this case.
Again, discuss all this with an attorney experienced in DWI/DUI cases.

   Finally, I would ask your friend to consider not drinking alcohol,
as it can tax her kiver. More importantly, suggest to her that she not
drive when she is drinking, even after one glass of champagne.

    ?There is no evidence to suggest that total abstinence from
alcohol is necessary when you have hepatitis C, unless you have
cirrhosis. However, it is recommended that people with hepatitis C who
consume alcohol in large quantities should reduce the amount they
drink, as alcohol does increase the rate of liver damage.

It is important to avoid alcohol when you are taking prescription
medications or other nonprescription drugs. The combination of drugs
can be unpredictable and may cause further liver damage?

Additional Information:

You may be able to glean some information about DWI/DUI in your state
from this site:

Further information on DUI. (I?m not sure most of this will hold up in
court, but speak to a lawyer.)

   There you go! If anything is unclear, please request an Answer
Clarification, and allow me to respond, before you rate. Good luck
with the case!

Sincerely, Crabcakes

Search Terms
Drugs + inhibit alcohol dehydrogenase
blood ammonia  + breathalyzer results
ETOH metabolism inhibition
Decreased alcohol metabolism
Drugs that decrease alcohol metabolism
Decreased alcohol metabolism
substances that inhibit alcohol metabolism
DWI  + defense
Hepatitis C + decreased alcohol metabolism
turtleheadtraders-ga rated this answer:4 out of 5 stars

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